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ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 252-260

Knowledge, attitude, and practice of Indian Endodontic postgraduate students regarding the COVID – 19 pandemic and its consequences: A cross-sectional study


1 Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Orthodontics and Dentofacial Orthopedics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Date of Submission02-Oct-2020
Date of Decision18-May-2021
Date of Acceptance16-Jul-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Sravanthi Tammineedi
Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_159_20

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  Abstract 


Aim: To assess the knowledge, attitude, and practice of Indian endodontic postgraduate students regarding the COVID-19 pandemic.
Methods: A questionnaire-based survey was designed and circulated amongst the endodontic postgraduate students at various colleges in India by convenience sampling and snowball sampling. A total of 540 voluntary responses were recorded. The survey consisted of 15 questions about their knowledge, attitude, and practice regarding the COVID-19 pandemic. Descriptive statistics were performed to analyze the demographic details, mean scores of knowledge, attitude, and practice among the participants. Chi-square tests were performed to assess the association between the demographic variables and the questions. Pearson's correlation test was performed to study the association.
Results: Indian endodontic postgraduate students have adequate knowledge (64.7%), attitude (80%), and practice scores (85%). Good knowledge and attitude scores were associated with the place (P = 0.0004) and year of studying (P < 0.0001). Good practice was associated with gender (P < 0.0001) and year of study (P < 0.0001). Positive correlation was observed between knowledge and attitude (r = 0.92, P < 0.0001), knowledge and practice (r = 0.76, < 0.0001), and attitude and practice (r = 0.70, < 0.0001).
Conclusion: The Indian endodontic postgraduate students who participated in the study showed adequate knowledge, attitude, and practice with few lacunae. Decision-making regarding the treatments to be performed and fear of hindered academic and clinical skills need to be addressed.

Keywords: Attitude, COVID-19, knowledge, practice, survey


How to cite this article:
Tammineedi S, Bolla N, Basam RC, Vemuri S, Chukka R, Basam LC. Knowledge, attitude, and practice of Indian Endodontic postgraduate students regarding the COVID – 19 pandemic and its consequences: A cross-sectional study. J NTR Univ Health Sci 2021;10:252-60

How to cite this URL:
Tammineedi S, Bolla N, Basam RC, Vemuri S, Chukka R, Basam LC. Knowledge, attitude, and practice of Indian Endodontic postgraduate students regarding the COVID – 19 pandemic and its consequences: A cross-sectional study. J NTR Univ Health Sci [serial online] 2021 [cited 2022 May 28];10:252-60. Available from: https://www.jdrntruhs.org/text.asp?2021/10/4/252/339814




  Introduction Top


The recent outbreak of corona virus disease (COVID-19) has gripped the entire dental health care community and has caused widespread dental health concerns. Despite the global efforts to contain the spread of infection, there is a surge in COVID-19 infection. This pandemic has simultaneously induced an epidemic of anxiety. Feelings of anxiety are increasingly common among dental health care professionals as they are fearful of themselves or the family members falling ill and also about the uncertainty of the pandemic's unintended consequences. A recent Chinese study also reported that the frontline dental staff was more likely to suffer from anxiety disorders compared to the general public.[1] Dental professionals, including endodontists, may come across patients with suspected or confirmed COVID-19 infection. There is greater aerosol production during the various treatment procedures performed in the specialty of endodontics and there is a high risk of exposure of endodontic postgraduate students to the infection. They should be able to tackle the situations by following strict and effective infection control protocols if such an encounter happens.[2] Postgraduate students' compliance with the prevention measures is essential for curtailing the spread of infection, which is affected by their knowledge, attitude, and practices (KAP) towards COVID-19. The literature search showed few KAP studies conducted among medical students as well as dental practitioners.[3],[4] However, there are no studies evaluating the KAP of Indian endodontic postgraduate students who are at high risk of exposure. Hence, we aimed to assess the knowledge, attitude, and practice of endodontic postgraduate students during the COVID-19 pandemic.


  Materials and Methods Top


The present cross-sectional study was conducted amongst the endodontic postgraduate students at various colleges in India. An exemption to the ethical clearance was acquired for this survey as the study was carried out during the health emergency, and personal identification details such as name, e-mail address, and phone number were not collected. Only the investigators had access to the collected data. The study objectives were clearly described at the beginning of the questionnaire, and confidentiality of the obtained data was assured. The self-designed questionnaire was prepared in the English language using Google form. The survey was given initially to ten endodontists, and the questionnaire was evaluated. Internal reliability (assess the consistency of the results between the items within a test) of the questionnaire was found to be 0.80 Cronbach coefficient. Mean content validity ratio (CVR) was calculated as 0.86. Google form link was circulated through personal contacts and social media by convenience sampling and snowball sampling (The study participants were requested to forward the questionnaire to their known colleagues). Responses were collected over 1 month, i.e., April 15 to May 15 following which the google form was incapacitated for further responses. A total of 540 students participated voluntarily in the survey [Flowchart 1]. All participants were made anonymous, and consent was obtained. Three questions were directed to know the participants' profiles, i.e., gender, area, and year of study. The remaining questionnaire was divided into three sections, as follows:



Section A – Included five questions evaluating the knowledge of postgraduate students regarding the COVID-19. One mark was allocated for the correct answer, whereas 0 mark for the wrong answer. Hence, the total marks ranged from 0 to 5 for knowledge questions.

Section B – Included five questions assessing postgraduate students' attitudes towards the COVID-19 pandemic and its consequences. Answers to these questions were judged on a Likert scale ranging from 1 to 5. Strongly disagree was given 1 mark, and strongly agree was given 5 marks. The total score for these five questions ranged from 5 to 25.

Section C – Included five questions regarding the practice during COVID-19. One mark was allocated for the correct answer, whereas 0 mark for the wrong answer. Hence, the total marks ranged from 0 to 5.

Statistical analysis

Descriptive statistics were used to analyze the study participants' demographic details and their knowledge, attitude, and practice scores. Pearson's correlation was used to analyze the correlation between knowledge, attitude, and practice among study subjects and Chi-square test for association between demographic variables with knowledge, attitude, and practice regarding COVID-19. The statistical analysis was performed using IBM SPSS 21.0. The statistical significance was set at P value less than 0.05.


  Results Top


[Table 1] shows the participants' profile. Out of 540 participants, 344 (63.6%) were female, and 196 (36.4%) were male. Most of the responses, 269 (49.8%) were obtained from south India. No responses were obtained from east India. Also, the majority of the participants, 216 (40%) were from the second year of their postgraduate course.
Table 1: Demographic details of study participants

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[Table 2] shows that 350 (64.7%) participants had adequate knowledge regarding COVID-19. Knowledge deficit was noted regarding the laboratory testing of COVID-19 and the administration of hydroxychloroquine. A total of 432 (80%) study participants had the right attitude. A total of 78% of the participants were worried about the consequences of contracting the COVID-19 to the family members. The majority of them, 458 (85%) were having good practice scores. They lacked decision-making regarding when to perform treatments to a dental patient reporting to them during the pandemic.
Table 2: Knowledge, attitude, and practice among the study participants

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[Table 3] shows the correlation of knowledge, attitude, and practice among the participants. A significant correlation (r = 0.92, P < 0.0001) was observed between knowledge, attitude, and knowledge, practice (r = 0.76, P < 0.0001). Significant correlation was also observed between attitude and practice (r = 0.70, P < 0.0001).
Table 3: Correlation analysis of knowledge, attitude, and practice among participants using pearson's correlation

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[Table 4] depicts the descriptive statistics regarding the percentage of participant's knowledge, attitude, and practice status. [Table 5] shows the correlation between the demographics and all three aspects. Practice (< 0.0001) of the participants was significantly correlated to the gender of the study participants, with males showing better practices. There was no difference between the knowledge and attitude levels between males and females. The place of the study was significantly correlated to the knowledge (0.0004) and attitude (< 0.0001) of the participants. North and south Indians had better knowledge, whereas north Indians' attitude was less compared to south and west India. The year of studying the course had a significant correlation with the knowledge (< 0.0001), attitude (< 0.0001), and gender (< 0.0001) of the participant. The III MDS students had better knowledge, attitude, and practice compared to I, II MDS students.
Table 4: Descriptive statistics showing the percentage of participants having knowledge, attitude, and practice

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Table 5: Correlation analysis of demographic variables with knowledge, attitude, and practice using chi-square test

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  Discussion Top


The novel coronavirus is a member of the Coronaviridae family, consists of single-stranded RNA. The published genome sequence for this novel coronavirus resembles other beta-coronaviruses such as SARS-CoV-2 and MERS-CoV. Hence, the scientific name SARS-CoV-2. Later, on February 11, 2020, WHO announced “COVID-19” as the name of this new disease.[5] The rapid spread of the disease and no specific treatment necessitates the need to prevent the disease. For prevention, adequate knowledge, a good attitude, and practices towards COVID-19 are needed. Very few studies conducted were focused on dental practitioners.[4],[6] There are no studies evaluating the knowledge, attitude, and practice among Indian endodontic postgraduate students.

The knowledge levels of Indian endodontic postgraduate students (64.7%) regarding the COVID-19 pandemic is less compared with the knowledge scores among medical students (86.7%) as reported by Maheshwari et al.[3] and among the dental practitioners (92.7%) by Kamate et al.[4] The variation was because of the multinational data collected in their study. The scores obtained are higher than those reported by Asaad et al.[7] (MERS-CoV in south-western Saudi Arabia, 51%). Their study also reported that female participants showed better knowledge compared to male participants. On the contrary, the results were not statistically significant between males and females in our study. No comparative studies could be found considering the location and year of the study. In our study, third-year students had better knowledge which can be imparted to the better knowledge acquisition and assimilation from various sources. Few lacunae were observed regarding the questions of laboratory testing and hydroxychloroquine administration.

Strong opinion (92%) of the students to wear the respirator while examining outpatient, close contact with patients secretions or body fluids, and during aerosol-generating procedures is as per the recommendations proposed by the Indian Endodontic Society (IES), the International Federation of Endodontic Associations (IFEA), and the Indian Dental Association.[8] Earlier studies by Heinzerling, McMichael et al. reported that there is no data to gauge the risk of SARS-CoV-2 transmission during dental practice. They proposed that clusters of health care personnel who tested positive for COVID-19 were associated with hospital settings and long-term care facilities, but no clusters are reported in dental settings.[9],[10] In contrast, the strong opinion (90%) of postgraduate students regarding the risk of dentists to COVID-19 is in association with a recent study by Peng et al.,[11] where they reported that the dental professionals are at high risk of COVID-19 infection due to the close face-to-face contact with patients.

Participants had a good attitude score (80%). There was no statistically significant difference among the males and females, similar to the study by Maheshwari et al.[3] Better attitudes in the final year postgraduates can be correlated to their knowledge level. A total of 82% of the participants agreed that PPE reduces the risk of getting infected from the aerosol-generating procedures. Whereas, Kamate et al.[4] reported the PPE and hand hygiene are 100% effective in preventing infection. A total of 91% of respondents in the study by Maheshwari et al.[3] reported that they were using PPE more than they used to do. Seventy-six percent of the participants in our study were worried about the consequences of contracting the virus to their family members. This is similar to a study by Asaad et al.[7] (MERS, 70%, health care professionals). Sixty-two percent of the students shared a positive experience with e-learning, but they felt that this pandemic would hinder their clinical and academic skills. Kapasia et al.[12] surveyed the learning status of undergraduate and postgraduate students during the COVID-19 pandemic and concluded that despite a substantial proportion of students are using digital platforms for learning, many of them are facing huge challenges in studying online. At this juncture, the open-source digital learning and learning management system could be maintained by the institution and specialty associations to conduct online learning.

Good practice scores (85%) recorded by the participants are similar to those presented by Kamate et al.[4] (COVID-19, 80%, dental practitioners). The higher values were noted in the case of males and also participants studying the third year. Therefore, it is recommended that female participants and those in first and second-year postgraduation pay more attention to practice. A total of 87% of the participants replied that personal protective equipment, the practice of four-hand dentistry, rubber dam isolation, use of high volume evacuation, and minimizing the practice of aerosol-generating procedures are recommended to decrease the risk of getting infected.

The risk of cross-infection could be high between dental practitioners and COVID-19 patients (Dave et al., 2020[13]; Martelli-Júnior et al., 2020[14], Amber et al., 2020[15]). Hence, every care must be taken to minimize the spread of infection. Students had adequate practices regarding the methods to reduce cross-infection (89%). They maintained proper infection control procedures and biomedical waste disposal management. Eighty-five percent of them reported that social distancing is maintained in between patients. Only 61% of the participants were able to focus on their write-ups of library dissertations or research. This could be due to stress among the students. Ahmed et al.[16] reported that dental practitioners around the globe are in a state of anxiety and fear during this pandemic. In the present study, only 43% of the participants had decision-making skills regarding when to perform dental treatment procedures. The Indian Endodontic Society (IES), the International Federation of Endodontic Associations (IFEA), and the Indian Dental Association proposed immediate postponement of all elective dental procedures while keeping emergency services operational.[8] Every patient entering the clinic must be considered an asymptomatic carrier of COVID-19 and thorough precheck triage, infection control procedures are to be followed to minimize the risk of COVID-19 infection.

The results of our study depict a positive correlation between knowledge, attitude, and practice. Students with a more positive attitude towards COVID-19 tend to gather more information and develop their knowledge. More the knowledge, the better will be the practice during the pandemic. This study's findings can aid in preparing national health strategies and plans targeting the specific groups with poor findings and increasing their knowledge, attitude, and practice during COVID-19.

The study is prone to some limitations like selection bias due to the method of sampling employed. Secondly, social desirability bias may be observed. This was overcome by assuring the participants that the data was kept confidential, and no personal details were recorded. Survey fatigue is another limitation that is addressed in our study by having only 15 questions, and no irrelevant data is collected. Although we presented encouraging results, large-scale health educational programs regarding COVID-19 should be initiated by management or health care professional bodies to fill those lacunae and reinforce the knowledge.


  Conclusion Top


The Indian endodontic postgraduate students who participated in the study showed adequate knowledge, attitude, and practice regarding COVID-19 with few lacunae. Decision-making regarding the treatments to be performed, fear of hindered academic and clinical skills need to be addressed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Questionnaire Top


Specify your gender

Male

Female

Location of your post graduate study

North India

South India

East India

West India

Specify year of study

I MDS

II MDS

III MDS

SECTION - A

  1. What kind of genetic material was corona comprised of?


    1. Double Stranded (DS) DNA
    2. Single Stranded (SS) DNA
    3. Single Stranded (SS) RNA
    4. Double Stranded (DS) RNA


  2. Is rapid antibody testing a confirmatory test for COVID-19?


    1. Yes
    2. No
    3. May Be
    4. Don't Know


  3. Should Endodontists administer ICMR recommended prophylactic dose of Hydroxychloroquine?


    1. Yes
    2. No
    3. Don't know


  4. Appropriateness of wearing Respirator mask


    1. While examining Out Patient
    2. During close contact with patient's secretions and body fluids
    3. During performing procedures that generate aerosols
    4. All of the above


  5. Are dentists are at high risk of exposure to COVID-19?


  1. Yes
  2. No
  3. Cant say


SECTION - B

  1. Do you agree wearing of PPE reduces the risk of getting infected from aerosol generating procedures?


    1. Strongly agree
    2. Agree
    3. Neutral
    4. Disagree
    5. strongly disagree


  2. Do you are agree to attend the covid-19 postings, if assigned, during this outbreak?


    1. Strongly agree
    2. Agree
    3. Neutral
    4. Disagree
    5. Strongly disagree


  3. Are you not worried about the consequences of contracting covid-19 to your family members?


    1. Strongly agree
    2. Agree
    3. Neutral
    4. Disagree
    5. Strongly disagree


  4. Did you have a positive experience with e-learning during COVID-19 pandemic?


    1. strongly agree
    2. Agree
    3. Neutral
    4. Disagree
    5. strongly disagree


  5. Do you feel that this pandemic will hinder your academic and the clinical skills?


  1. Strongly agree
  2. Agree
  3. Neutral
  4. Disagree
  5. Strongly Disagree


SECTION- C

  1. When do you provide treatments for a dental patient who comes to your OPD?


    1. Elective cases after recording meticulous history of travel & residence from the past 6 months, free of Covid-19 symptoms
    2. Urgent cases after recording meticulous history of travel & residence from the past 6 months, free of Covid-19 symptoms
    3. Emergency cases after recording meticulous history of travel & residence from the past 6 months, free of Covid-19 symptoms
    4. All of the above


  2. How do you reduce the risk of getting exposed to the secretions and body fluids of patients while performing the treatment procedures?


    1. By wearing PPE and proper isolation procedures such as application of rubber dam and gingival retraction
    2. Minimizing aerosol generating procedures.
    3. By implementing 4 handed dentistry.
    4. Use of high volume evacuators.
    5. All of the above


  3. How do you prevent cross-contamination from the procedures performed on patients?


    1. By following adequate infection control measures with proper disinfection and sterilization methods.
    2. By keeping the operatory and non-operatory areas free of contamination.
    3. Following proper bio-medical waste disposal and management.
    4. All of the above


  4. Is social distancing maintained between the patients?


    1. Yes
    2. No
    3. Not much


  5. Are you able to focus on your library dissertation, research work writeups during this lockdown period?


  1. Yes
  2. No
  3. Not much




 
  References Top

1.
Zhao S, Cao J, Sun R, Zhang L, Liu B. Analysis of anxiety-related factors amongst frontline dental staff during the COVID-19 pandemic in Yichang, China. BMC Oral Health 2020;20:342.  Back to cited text no. 1
    
2.
Farooq I, Ali S. COVID-19 outbreak and its monetary implications for dental practices, hospitals and healthcare workers. Postgrad Med J 2020;96:791-2.  Back to cited text no. 2
    
3.
Maheshwari S, Gupta PK, Sinha R, Rawat P. Knowledge, attitude, and practice towards coronavirus disease 2019 (COVID-19) among medical students: A cross-sectional study. J Acute Dis 2020;9:100-4.  Back to cited text no. 3
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4.
Kamate SK, Sharma S, Thakar S, Srivastava D, Sengupta K, Hadi AJ, et al. Assessing knowledge, attitudes and practices of dental practitioners regarding the COVID-19 pandemic: A multinational study. Dent Med Probl 2020;57:11-7.  Back to cited text no. 4
    
5.
WHO. Naming the coronavirus disease (COVID-19) and the virus that causes it. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it.  Back to cited text no. 5
    
6.
Khader Y, Al Nsour M, Al-Batayneh OB, Saadeh R, Bashier H, Alfaqih M, et al. Dentists' awareness, perception, and attitude regarding COVID-19 and infection control: Cross-sectional study among Jordanian dentists. JMIR Public Health Surveill 2020;6:e18798. doi: 10.2196/18798.  Back to cited text no. 6
    
7.
Asaad A, El-Sokkary R, Alzamanan M, El-Shafei M. Knowledge and attitudes towards Middle East respiratory sydrome-coronavirus (MERS-CoV) among health care workers in south-western Saudi Arabia. East Mediterr Health J 2020;26:435-42.  Back to cited text no. 7
    
8.
Krithikadatta J, Nawal RR, Amalavathy K, McLean W, Gopikrishna V. Endodontic and dental practice during COVID-19 pandemic: Position statement from the Indian Endodontic Society, Indian Dental Association, and International Federation of Endodontic Associations. Endodontology 2020;32:55-66.  Back to cited text no. 8
  [Full text]  
9.
Heinzerling A, Stuckey MJ, Scheuer T, Xu K, Perkins KM, Resseger H, et al. Transmission of COVID-19 to health care personnel during exposures to a hospitalized patient - Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep 2020;69:472-6.  Back to cited text no. 9
    
10.
McMichael TM, Clark S, Pogosjans S, Kay M, Lewis J, Baer A, et al. COVID-19 in a long-term care facility - King County, Washington, February 27-March 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:339-42.  Back to cited text no. 10
    
11.
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:9.  Back to cited text no. 11
    
12.
Kapasia N, Paul P, Roy A, Saha J, Zaveri A, Mallick R, et al. Impact of lockdown on learning status of undergraduate and postgraduate students during COVID-19 pandemic in West Bengal, India. Child Youth Serv Rev 2020;116:105194.  Back to cited text no. 12
    
13.
Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet 2020;395:1257.  Back to cited text no. 13
    
14.
Martelli-Júnior H, Machado RA, Martelli DRB, Coletta RD. Dental journals and coronavirus disease (COVID-19): A current view. Oral Oncol 2020;106:104664.  Back to cited text no. 14
    
15.
Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): Implications for clinical dental care. J Endod 2020;46:584-95.  Back to cited text no. 15
    
16.
Ahmed MA, Jouhar R, Ahmed N, Adnan S, Aftab M, Zafar MS, et al. Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak. Int J Environ Res Public Health 2020;17:2821.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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